췌장의 관내 유두상 점액종의 임상적, 병리학적 고찰

Abstract

Purpose: Intraductal papillary mucinous tumors of the pancreas (IPMT) are becoming increasingly recognized. Despite a better understanding of these conditions, IPMT still present difficulty relating to the predictive factors and the risk of relapse after surgery. The aim of this study was to investigate the clinical, and pathological characteristics of IPMT.

Methods: Between October 1998 and July 2002, 22 patients with IPMT underwent surgery. We retrospectively examined the clinicopathological features and surgical outcomes of these patients.

Results: The types of IPMT were as follows: dysplasia (1); adenoma (4); borderline malignancy (9); carcinoma in situ (3); and carcinoma, both non-invasive (3) and invasive (2). Lymph node metastasis was not found, but stromal invasion was found in the 2 cases of invasive carcinoma. The locations of the IPMT were as follows: head (6); uncinate process (11); body (4); and tail (1). There were 11 main duct types, 10 branched duct types and 1 combined. All patients underwent surgical resection, including 3 pancreaticoduodenectomies, 12 pylorus-preserving pancreaticoduodenectomies, 4 distal pancreatectomies with splenectomies, 2 near-total pancreatectomies with splenectomies, and 1 enucleation. There were no operative or hospital deaths. A recurrence of the IPMT following surgery occurred in 2 cases. Their pathological features were a carcinoma in situ and a borderline malignancy, but not the invasive type. However, one case of recurrence expired 7 month after surgery. A combination of other malignancies in these patients was found in 2 cases.

Conclusion: IPMT has a favorable prognosis, when compared with pancreatic duct carcinoma. However, long-term follow-up after surgery is necessary, even for a curative resection due to a recurrence or a combination of other malignancies. Because combination of other malignancies exist infrequently, surgeons should be aware of the possibility of co-existing other malignancies.